title: An alternative strategy for perinatal verbal autopsy coding: single versus multiple coders.
abstract: OBJECTIVE
  To determine the comparability between cause of death (COD) by a single physician coder and a two-physician panel, using verbal autopsy.
  
  
  METHODS
  The study was conducted between May 2007 and June 2008. Within a week of a perinatal death in 38 rural remote communities in Guatemala, the Democratic Republic of Congo, Zambia and Pakistan, VA questionnaires were completed. Two independent physicians, unaware of the others decisions, assigned an underlying COD, in accordance with the causes listed in the chapter headings of the International classification diseases and related health problems, 10th revision (ICD-10). Cohen's kappa statistic was used to assess level of agreement between physician coders.
  
  
  RESULTS
  There were 9461 births during the study period; 252 deaths met study enrolment criteria and underwent verbal autopsy. Physicians assigned the same COD for 75% of stillbirths (SB) (K = 0.69; 95% confidence interval: 0.61-0.78) and 82% early neonatal deaths (END) (K = 0.75; 95% confidence interval: 0.65-0.84). The patterns and proportion of SBs and ENDs determined by the physician coders were very similar compared to causes individually assigned by each physician. Similarly, rank order of the top five causes of SB and END was identical for each physician.
  
  
  CONCLUSIONS
  This study raises important questions about the utility of a system of multiple coders that is currently widely accepted and speculates that a single physician coder may be an effective and economical alternative to VA programmes that use traditional two-physician panels to assign COD.
authors.affiliation: Department of Pediatrics, University of North Carolina, School of Medicine, Chapel Hill, NC 27599-7596, USA. USA. cengmann@med.unc.edu
authors.forename: C
authors.initials: C
authors.lastname: Engmann
authors.forename: I
authors.initials: I
authors.lastname: Jehan
authors.forename: J
authors.initials: J
authors.lastname: Ditekemena
authors.forename: A
authors.initials: A
authors.lastname: Garces
authors.forename: M
authors.initials: M
authors.lastname: Phiri
authors.forename: M
authors.initials: M
authors.lastname: Mazariegos
authors.forename: E
authors.initials: E
authors.lastname: Chomba
authors.forename: O
authors.initials: O
authors.lastname: Pasha
authors.forename: A
authors.initials: A
authors.lastname: Tshefu
authors.forename: E M
authors.initials: EM
authors.lastname: McClure
authors.forename: V
authors.initials: V
authors.lastname: Thorsten
authors.forename: H
authors.initials: H
authors.lastname: Chakraborty
authors.forename: R L
authors.initials: RL
authors.lastname: Goldenberg
authors.forename: C
authors.initials: C
authors.lastname: Bose
authors.forename: W A
authors.initials: WA
authors.lastname: Carlo
authors.forename: L L
authors.initials: LL
authors.lastname: Wright
mesh_terms: D001344:Autopsy; D002423:Cause of Death; D059019:Clinical Coding / Q000379:methods*; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D015588:Observer Variation; D010154:Pakistan / Q000453:epidemiology; D054238:Perinatal Mortality; D011446:Prospective Studies; D015203:Reproducibility of Results; D050497:Stillbirth / Q000453:epidemiology*; D015024:Zambia / Q000453:epidemiology